Coronavirus cases in India increase to six, numbers expected to rise

Corona- Screening-Optimized

Two Indians who arrived from Italy and Dubai and an Italian tourist in Jaipur were found to positive for novel coronavirus (SARS-CoV-2) on March 2 and March 3, respectively. With this the total number of cases reported from India has risen to six.

On March 2, India reported two more coronavirus disease (COVID-19) cases — one each from Delhi and Hyderabad — bringing the total number to five, excluding the Italian tourist in Jaipur confirmed on March 3. While the first three cases reported from Kerala were in young adults who had arrived in India directly from China, the recent two have been in Indians who had arrived from Italy and Dubai. Both Italy and UAE have reported local transmission of the novel coronavirus (SARS-CoV-2), thus marking all the five as imported cases.

Detection of the three new cases does not come as a surprise considering that hundreds of passengers have arrived in India from China and other countries where local transmission of the virus has been going on for the last couple of weeks.

Six contacts “detected with high viral load”

On Tuesday, the Ministry of Health and Family Welfare informed that six people in Agra who had come in contact with the COVID-19 index case in Delhi have been “detected with high viral load” and have been kept in isolation. Their samples have now been sent to the Pune-based National Institute of Virology for confirmation. If even one of the six is confirmed to be positive for the virus, it would indicate local transmission of SARS-CoV-2 and will automatically change the status of virus spread in the country.

Also, 24 persons (21 Italian tourists and three Indians), who had contact with the Italian national who was confirmed as COVID-19 positive in Jaipur on March 3, have been shifted to the Indo-Tibetan Border Police (ITBP) facility for testing.

The silver lining is that it highlights the ability of the system to trace and test people who have come in contact with the index cases. Community transmission should not come as a surprise in light of the fact that the six confirmed cases had come in contact with many people before their infection status was confirmed.

In hot pursuit to trace contacts

The Health Ministry’s Integrated Disease Surveillance Program (IDSP) network is in hot pursuit to trace people who have come in contact with the six people whose samples have been sent for confirmation. Already, about 26,000 passengers who have arrived from various countries have been put under community surveillance of the IDSP network.

Care should be taken to ensure that people under community surveillance do not flee, as was the case in Kerala when two adults under observation for coronavirus left the country unnoticed.

Limitations with thermal screening

While thermal screening at airports do help in detecting people with a fever so that further screening and testing can be performed to ascertain the infection status, it is essential that people who have arrived in the country seek immediate medical care and testing when symptoms show up days after landing.

The median incubation period after infection is three days; the incubation period can also last more than three weeks as per one study. Infected people do not show symptoms during the incubation period and hence thermal screening at airports and seaports will be unable to detect such cases. It is therefore heartening that universal screening of passengers arriving from 12 countries is being undertaken.

It is also important that people and all healthcare providers across the country are made aware that molecular testing does not have very high sensitivity and hence may turn up false negatives. It is therefore essential that at least two negative tests are needed before a person is certified as being uninfected.

Published in The Hindu on March 4, 2020